Michael Sandel The case against perfection ethics in the age of genetic engineering The Case against Perfection explores these and other moral quandaries connected with the quest to perfect ourselves and our children. Michael Sandel argues that the pursuit of perfection is flawed for reasons that go beyond safety and fairness. The drive to enhance human nature through genetic technologies is objectionable because it represents a bid for mastery and dominion that fails to appreciate the gifted character of human powers and achievements. Carrying us beyond familiar terms of political discourse, this book contends that the genetic revolution will change the way philosophers discuss ethics and will force spiritual questions back onto the political agenda.
The Case against Perfection The Case against Perfection ETHICS IN GENETIC THE AGE OF ENGINEERING Michael J Sandel THE BELKNAP HARVARD PRESS UNIVERSITY OF PRESS Cambridge, Massachusetts, and London, England 2007 Copyright © 2007 by Michael J Sandel All rights reserved Printed in the United States of America Library of Congress Cataloging-in-Publication Data Sandel, Michael J The case against perfection : ethics in the age of genetic engineering / Michael J Sandel p cm Includes bibliographical references and index ISBN-13: 978-0-674-01927-0 (alk paper) ISBN-10: 0-674-01927-X (alk paper) Genetic engineering—Moral and ethical aspects I Title QH438.7.S2634 2007 174′.957—dc22 2006039327 For Adam and Aaron Acknowledgments My interest in ethics and biotechnology was prompted by an unexpected invitation, in late 2001, to serve on the newly formed President’s Council on Bioethics Although I am not a professional bioethicist, I was intrigued by the prospect of thinking my way through controversies over stem cell research, cloning, and genetic engineering in the company of a distinguished group of scientists, philosophers, theologians, physicians, legal scholars, and public policy experts I found the discussions enormously stimulating and intellectually intense, so much so that I decided to pursue some of the topics in my teaching and writing Leon Kass, who chaired the council during the four years I served, was largely responsible for the high level of the discussions Although he and I have strong philosophical and political differences, I admire Leon’s unerring eye for important questions and vii acknowledgments am grateful to him for having embroiled the council, and me, in far-reaching bioethical inquiries the likes of which few governmental bodies undertake One of the questions that most intrigued me concerned the ethics of genetic enhancement I wrote a short discussion paper on the subject for the council, and, with the encouragement of Cullen Murphy, developed it into an essay for the Atlantic Monthly in 2004 Cullen is a writer’s dream editor—a smart, sympathetic critic with a keen moral sensibility and exquisite editorial judgment I am indebted to Cullen for suggesting the title of this book, and for nurturing the essay of the same title that first appeared in the pages of his magazine I am also grateful to Corby Kummer, who helped edit the essay from which this book was born For the past several years I have had the privilege of exploring the themes of this book with Harvard undergraduates, graduate students, and law students in seminars I have taught on ethics and biotechnology In 2006 I teamed up with my colleague and friend Douglas Melton to teach a new undergraduate course, Ethics, Biotechnology, and the Future of Human Nature More than a distinguished biologist and stem cell pioneer, Doug has viii acknowledgments the philosopher’s knack for asking seemingly innocent questions that go to the heart of the matter It has been a great pleasure to explore these questions in his company I am grateful for having had the opportunity to try out various of the arguments presented in this book in the Moffett Lecture at Princeton University; the Geller Lecture at NYU School of Medicine; the Dasan Memorial Lecture in Seoul, South Korea; a public lecture at an international conference in Berlin organized by the Deutsches Referenzzentrum für Ethik in den Biowissenschaften (DRZE); a public lecture at the Collège de France, Paris; and a bioethics colloquium cosponsored by the National Institutes of Health, Johns Hopkins University, and Georgetown University I learned a great deal from the comments and criticisms offered by participants in those occasions I am also grateful for the support of the Harvard Law School summer research program, and the Carnegie Scholars program of the Carnegie Corporation, which graciously allowed me this intellectual detour along the way to a future (and not wholly unrelated) project on the moral limits of markets I would like also to record my thanks to Michael Aronson, my editor at Harvard University Press, ix Notes to Pages 90–95 testing generally, see Erik Parens and Adrienne Asch, eds., Prenatal Testing and Disability Rights (Washington, DC: Georgetown University Press, 2000) See Laurie McGinley, “Senate Approves Bill Banning Bias Based on Genetics,” Wall Street Journal, October 15, 2003, p D11 See John Rawls, A Theory of Justice (Cambridge, MA: Harvard University Press, 1971), pp 72–75, 102–105 This challenge to my argument has been posed, from different points of view, by Carson Strong, in “Lost in Translation,” American Journal of Bioethics (May-June 2005): 29–31, and by Robert P George, in discussion at a meeting of the President’s Council on Bioethics, December 12, 2002 (transcript at http://www.bioethics.gov/transcripts/dec02/session4.html) For illuminating discussion of the way modern self-understandings draw in complex ways on unacknowledged moral sources, see Charles Taylor, Sources of the Self (Cambridge, MA: Harvard University Press, 1989) See Frances M Kamm, “Is There a Problem with Enhancement?” American Journal of Bioethics (May-June 2005): 1–10 Kamm, in a 148 Notes to Pages 96–98 thoughtful critique of an earlier version of my argument, construes what I call the “drive” or “disposition” to mastery as a desire or motive of individual agents, and argues that acting on such a desire would not render enhancement impermissible I am indebted to the discussion of this point by Patrick Andrew Thronson in his undergraduate honors thesis, “Enhancement and Reflection: Korsgaard, Heidegger, and the Foundations of Ethical Discourse,” Harvard University, December 3, 2004; see also Jason Robert Scott, “Human Dispossession and Human Enhancement,” American Journal of Bioethics (May-June 2005): 27–28 See Isaiah Berlin, “John Stuart Mill and the Ends of Life,” in Berlin, Four Essays on Liberty (London: Oxford University Press, 1969), p 193, quoting Kant: “Out of the crooked timber of humanity no straight thing was ever made.” 10 Robert L Sinsheimer, “The Prospect of Designed Genetic Change,” Engineering and Science Magazine, April 1969 (California Institute of Technology) Reprinted in Ruth F Chadwick, ed., Ethics, Reproduction and Genetic Control (London: Routledge, 1994), pp 144–145 149 Notes to Pages 98–106 11 Ibid., p 145 12 Ibid., pp 145–146 Epilogue: Embryo Ethics “President Discusses Stem Cell Research Policy,” Office of the Press Secretary, the White House, July 19, 2006, at http:// www.whitehouse.gov/news/releases/2006/07/ 20060719-3.html; George W Bush, “Message to the House of Representatives,” Office of the Press Secretary, the White House, July 19, 2006, at http://www.whitehouse.gov/news/releases/2006/ 07/20060719-5.html Press briefing by Tony Snow, Office of the Press Secretary, the White House, July 18, 2006, at http://www.whitehouse.gov/news/releases/2006/07/ 20060718.html; press briefing by Tony Snow, Office of the Press Secretary, the White House, July 24, 2006, at http://www.whitehouse.gov/news/ releases/2006/07/20060724-4.html; Peter Baker, “White House Softens Tone on Embryo Use,” Washington Post, July 25, 2006, p A7 The British legislation, the Human Reproductive Cloning Act 2001, may be found at http:// www.opsi.gov.uk/acts/acts2001/20010023.htm Senator Sam Brownback, testimony before Sen- 150 Notes to Pages 106–107 ate Appropriations Labor, HHS, and Education Subcommittee, Washington, DC, April 26, 2000, quoted in Brownback press release, “Brownback Opposes Embryonic Stem Cell Research at Hearing Today,” April 26, 2000, available at http://brownback.senate.gov/pressapp/record.cfm?id=176080&&year=2000& Brownback address at the annual March for Life gathering in Washington, DC, January 22, 2002, quoted in Brownback press release, “Brownback Speaks at Right to Life March,” January 22, 2002, available at http://brownback.senate.gov/ pressapp/record.cfm?id=180278&&year=2002& My discussion in this section draws on and elaborates the argument I presented in Sandel, “The Anti-Cloning Conundrum,” New York Times, May 28, 2002, and in my personal statement in Human Cloning and Human Dignity: Report of the President’s Council on Bioethics (New York: PublicAffairs, 2002), pp 343–347 Senator Bill Frist, Congressional Record—Senate, 107th Cong., 2nd sess., Vol 148, no 37, April 9, 2002, pp 2384–2385; Bill Frist, “Not Ready for Human Cloning,” Washington Post, April 11, 2002, p A29; Bill Frist, “Meeting Stem Cells’ Promise—Ethically,” Washington Post, July 18, 2006; Mitt Romney, “The Problem with the 151 Notes to Pages 109–116 Stem Cell Bill,” Boston Globe, March 6, 2005, p D11 Charles Krauthammer, “Crossing Lines,” New Republic, April 29, 2002, p 23 For a helpful discussion of the intend/foresee distinction as applied to the cloning and stem cell debates, see William Fitzpatrick, “Surplus Embryos, Nonreproductive Cloning, and the Intend/Foresee Distinction,” Hastings Center Report, May-June 2003, pp 29–36 10 Nicholas Wade, “Clinics Hold More Embryos Than Had Been Thought,” New York Times, May 9, 2003, p 24 11 The phrase “nothing is lost” is from Gene Outka, “The Ethics of Human Stem Cell Research,” Kennedy Institute of Ethics Journal 12, no (2002): 175–213 Outka defends the compromise position I criticize See also the discussion of Outka’s “nothing is lost” principle at the President’s Council on Bioethics, April 25, 2002, at http://www.bioethics.gov/transcripts/apr02/ apr25session3.html 12 In this section and the next, I draw on and elaborate arguments I presented in Sandel, “Embryo Ethics: The Moral Logic of Stem Cell Research,” New England Journal of Medicine 351 (July 15, 2004): 207–209; and in Sandel, personal 152 Notes to Page 116 statement, Human Cloning and Human Dignity 13 Paul McHugh, my colleague on the President’s Council on Bioethics, advances this view See “Statement of Dr McHugh,” in the appendix to Human Cloning and Human Dignity: The Report of the President’s Council on Bioethics (New York: PublicAffairs, 2002), pp 332–333; and Paul McHugh, “Zygote and ‘Clonote’: The Ethical Use of Embryonic Stem Cells,” New England Journal of Medicine 351 (July 15, 2004): 209–211 When McHugh first voiced this suggestion in council discussions, he received criticism bordering on ridicule But subsequent testimony from Rudolph Jaenisch, an MIT stem cell biologist, offered scientific support for McHugh’s distinction between zygote and clonote See presentation by Rudolph Jaenisch and subsequent discussion, President’s Council on Bioethics, July 24, 2003, available at http:// www.bioethics.gov/transcripts/july03/ session3.html 14 For a critical discussion of this analogy, see Robert P George and Patrick Lee, “Acorns and Embryos,” New Atlantis (Fall 2004/Winter 2005): 90–100 Their article responds to Sandel, “Embryo Ethics.” 153 Notes to Pages 118–124 15 I am indebted to Richard Tuck for bringing sorites arguments to my attention, and to David Grewal for pointing out their relevance to the debate about the moral status of embryos 16 “President Discusses Stem Cell Research Policy,” Office of the Press Secretary, the White House, July 19, 2006, available at http:// www.whitehouse.gov/news/releases/2006/07/ 20060719-3.html 17 George J Annas, “A French Homunculus in a Tennessee Court,” Hastings Center Report 19 (November 1989): 20–22 18 In natural procreation, the rate of embryo loss is 60 to 80 percent According to Dr John M Opitz, professor of pediatrics, human genetics, and obstetrics/gynecology at the University of Utah School of Medicine, about 80 percent of fertilized eggs not survive, and about 60 percent of those that reach the seven-day stage not survive See Dr John M Opitz, presentation to the President’s Council on Bioethics, Washington, DC, January 16, 2003, at http:// www.bioethics.gov/transcripts/jan03/ session1.html A study published in the International Journal of Fertility found that at least 73 percent of natural conceptions not survive the first six weeks of gestation, and of those that 154 Note to Page 124 do, about 10 percent not survive to term See C E Boklage, “Survival Probability of Human Conceptions from Fertilization to Term,” International Journal of Fertility 35 (March-April 1990): 75–94 For discussion of the ethical implications of embryo loss in natural procreation, see John Harris, “Stem Cells, Sex, and Procreation,” Cambridge Quarterly of Healthcare Ethics 12 (2003): 353–371 155 Index Abortion, 19–20, 21, 71–72, 88– 89, 125 Adderall, 59, 60 Agar, Nicholas, 75 Agency, human, 26 Aging process, 10, 13, 14, 90 Alzheimer’s disease, 14 American Eugenics Society, 65 Americans with Disabilities Act, 42 Annas, George, 122 Arendt, Hannah, 82 Aristotle, 19 Artificial altitude training, 32– 34 Athletes, 8, 87; dietary practices of, 34–35; effort versus gift, 26–29; giftedness and, 93; muscle enhancement and, 10–13 Attention deficit and hyperactivity disorder (ADHD), 59, 60 Autonomy, 8, 9, 46, 96; children’s right to, 6–7, 75, 78– 80, 82, 83; liberal eugenics and, 75, 80, 81, 83 156 Baby boomers, 14, 55 Baby Ivies, 57 Bannister, Roger, 31–32 Baseball, 27, 36, 53, 137n16 Basketball, 17, 29, 36–37, 71, 87 Beta-blockers, 39 Bioengineering, 7, 61; as consumer choice, 10; height enhancement, 16–19; parenting and, 45; “self-made man” myth and, 86; sex selection, 19–23 See also Genetic engineering Bioethics, 47–48, 76 Biotechnology, 3–4, 10, 14, 19, 29, 85 Blastocyst, 102, 112–113, 115–116, 118–119, 127 See also Embryos Broadway musicals, 40–41 Brock, Dan W., 76 Brownback, Sen Sam, 106, 111 Buchanan, Allen, 76 Buck, Carrie, 66 Buck v Bell, 66 Bush (George W.) administration: and preschool testing, Index 58; stem cell policy, 102–103, 107, 119–121 California Cryobank, 73–75 Carbon Copy (cloned cat), Cats, cloned, 4–5 Cells, somatic (nonreproductive), Chance, 87–89, 92 Chariots of Fire (movie), 38, 42 Children: “designer children,” 7, 9, 75, 81, 99; drugs prescribed to, 59–61; genetic engineering of, 5; height enhancements for, 16–19; liberal eugenics and, 78–79, 82; parents’ drive to mastery and, 46–57; pressure to perform and, 57–62; right to autonomy, 6–7, 75, 83 China, sex ratios in, 22 Choice, 10, 68, 71, 73, 88–89, 97 Cloning, 6, 9, 24, 127; of humans, 5, 6, 68, 72; of pets, 4– 5; for reproduction, 6–7; for stem cell research, 104–111, 116 “Clonotes,” 116, 153n13 Cohen, Katherine, 56–57 College students, 54–57 Congress, U.S., 90, 102, 105, 120 Consumerism, 10, 54, 72, 75 Copernicus, Nicolaus, 99 Cosmetic endocrinology, 17 Crick, Francis, 70 Daniels, Norman, 76 Darwin, Charles, 63, 99 Davenport, Charles B., 64 Deafness, 1–2, 3, 4, 47 Dementia, 14 “Designer children,” 7, 9, 75, 81, 99 Diagnosis shopping, 55–56 Dignity, human, 24, 112, 113–114 Diller, Lawrence, 59 DiMaggio, Joe, 27 Disability, 1–2, 55, 88 Disease, 8, 46, 99; embryos screened for, 21; prevention of, 5; stem cell research and, 101, 102, 109–110, 127 Dogs, cloned, Dolly (cloned sheep), Down syndrome, 19, 88 Drugs: beta-blockers, 39; cognitive enhancers, 14; memory-suppressing, 15; performance-enhancing, 11, 28, 31, 35, 87–88, 89; stimulants, 59–61, 88 Duchesneau, Sharon, 1–2 Dworkin, Ronald, 76–77 Educational Testing Service, 55 Egg donors, 2–3, 72, 107–108 Eggs, human, 8, 20, 72–73, 128 Eli Lilly company, 17 Embryos: clones versus natural “spares,” 104–111; destruction of, 121, 122, 125; germline genetic intervention and, 8; moral status of, 111, 112–128; screening of, 20–21, 79; stem cells from, 102, 105 See also Blastocyst 157 Index Enhancement: as arms race, 18, 49; choice and, 71; consequentialism and, 92, 95–97; cosmetic surgery compared to, 8–9; critics and defenders of, 51–52, 68, 78; of height, 16–19; human agency and, 26; of memory, 13–16; moral objection to, 46; of muscles, 10–13; in music, 38–41; performance, 29– 36, 38, 87–88, 89; sanctity and, 92–95; social solidarity and, 89–92; sports and, 25 Equality, liberal principle of, 80, 81 Erythropoietin (EPO), 33 Eugenics, 48, 51, 85; free-market, 68, 69–75; Galton and, 63–64, 97; hyperparenting and, 62; liberal, 75–83; in Nazi Germany, 66–68; project of mastery and, 97–98; in Singapore, 69–70; solidarity and, 92; in United States, 64–66, 68 Fairness, 9, 11–12, 18 Fertility clinics, 106, 107–108, 110–111, 122, 128; MicroSort process and, 22; “spare” embryos in, 123 “Fitter Families” contests, 65 Flow cytometer, 22 Food and Drug Administration (FDA), 17 Football players, 34–35 Freedom, 24, 83, 96, 97, 147n37; contingent begin- 158 ning of life and, 81, 82, 94; erosion of agency and, 26; just society and, 73; Promethean mastery and, 99, 100 Free-market eugenics, 68, 69–75 Frist, Sen Bill, 107, 108 Fruit flies, 13 Galton, Sir Francis, 63–64, 97 Gattaca (movie), 21, 86 Genes, 8, 11, 33, 65, 90 Gene therapy, 8, 10, 11–12, 33 Genetic engineering, 6, 44, 85, 95–96; autonomy and, 7; choice and, 71, 91–92; education and training compared to, 51–52, 78; eugenics and, 68, 79; germline, 8; human freedom and, 25; memory enhancement, 13–16; muscle enhancement, 10–13; pressure to perform and, 61; project of mastery and, 99–100; reverence for life as gift and, 127 See also Bioengineering Genetic lottery, 3, 7, 77, 91–92, 98 Genetics & IVF Institute, 22 Genetic Savings & Clone, Genome, 75, 99 Germany, 66–68, 79, 110 Germ plasm, 73, 75 Gibson, Aaron, 34 Giftedness, 26–29, 45; eugenics and, 83; human dignity and, 85–92; sanctity and, 92–95 Graham, Robert, 73–74 Grubman, Jack, 57 Index Gumbrecht, Hans Ulrich, 137n16 Habermas, Jürgen, 79–82, 94 Harriman, Mrs E H., 64 Head Start, 58 Health, 47–49 Height enhancement, 16–19, 23, 49 Hitler, Adolf, 67 Holmes, Justice Oliver Wendell, 66 Hormone treatments, 16, 33 Horne, Marilyn, 40 Human growth hormone, 16– 18, 35, 41, 49 Humility, giftedness and, 85– 87, 95 Hyperparenting, 52–57 Hypoxic devices, 34 Independent Educational Consultants Association, 56 India, abortion of female fetuses in, 20, 22 Individualism, ethical, 76–77, 79 Infanticide, 21, 120, 123, 124 Infertility, 2–3, 22, 108 Insurance, 89–90, 92 Intelligence, 3, 9, 51; eugenics and, 65; intelligence quotient (IQ), 21, 23, 79, 98; standardized tests of, 58 International Olympic Committee (IOC), 11, 32–33 In vitro fertilization (IVF), 20, 108, 109, 110, 111; natural pregnancy and embryo loss, 124, 125, 154n18; “spare” embryos and, 122–123 IvyWise, 56–57 Jones, Marilee, 54 Jordan, Michael, 29, 37 Justice, 76, 77 Kant, Immanuel, 94, 114 Krauthammer, Charles, 109 Lee Kuan Yew, 69 Liberal eugenics, 75–83 Locke, John, 94 Marathon runners, 30, 32, 37– 38 Mastery, 95, 96, 149n7; control and, 46, 86, 89; dominion and, 46–47, 62, 83; giftedness and, 27, 101; mystery of birth and, 82–83; Promethean project of, 26, 27, 47, 89, 97– 100 May, William F., 45, 46, 49 McCullough, Candy, 1–2 Medicine, 46–47, 53, 101 Mein Kampf (Hitler), 67 Memory, 5, 13–16, 23 Meritocracy, 28, 91, 92 Mice, laboratory, 10, 13 Micheli, Lyle, 53 MicroSort process, 22, 23 Moods, 5, Morality: cloning and, 6–7; disability by design and, 1–2; of enhancements, 15–16, 24; genetic engineering and, 9; genetic unpredictability and, 159 Index Morality (continued) 3–4; inalienable rights and, 94–95; just society and, 80; responsibility and, 88; sex selection and, 21; stem cell research and, 103–104, 112–128 Muscles, enhancement of, 10– 13, 23 Music, 38–41, 51; giftedness and, 93 National Football League (NFL), 34, 35 Nature: eugenics and, 63; freedom and, 82; genetic lottery and, 98; manipulation of, 5; medicine and, 46–47, 101; moral status of, 9; reengineering of, 6; sanctity of, 93–94 Nazi Germany, 66–68 Nozick, Robert, 77 Nursery schools, 57 Old age, 10, 13, 14, 90 Olympics, 28 Opera singing, 39–40 Parents: child’s right to autonomy and, 6–7, 46; disability by design and, 1–2; egg donors and, 2–3; ethic of giftedness and, 45; eugenics and, 78–79, 82; height enhancement of children and, 16, 19; humility and, 86; impulse to mastery and, 46–57, 81, 82–83; moral responsibility and, 89; pressure on chil- 160 dren to perform, 57–62; sex selection of children, 19; transforming versus accepting love, 49–50 Performance enhancement: high and low tech, 29–36; in music, 38–41; in sports, 28, 29–36, 38 Personhood, 115, 116–119, 126 Pets, cloning of, 4–5 Pharmaceuticals industry, 14, 17 Philosophers, 9, 75, 79–83, 94, 118 Politics, 6, 10, 102–104, 105, 119–120 Preimplantation genetic diagnosis (PGD), 20–21, 72, 89 “Prospect of Designed Genetic Change, The” (Sinsheimer), 97 Racism, 64 Rawls, John, 77, 80 Religion, 80, 85, 92–93, 95; personhood of embryos and, 124; stem cell research and, 113 Repository for Germinal Choice, 73 Respect, warrant for, 125–128 Responsibility, giftedness and, 85, 86, 87–89, 95 Reverence, 85, 93–94, 101, 127 Rights, individual, 9, 94–95, 96 Ritalin, 59–60 Roberts, Selena, 34 Rockefeller, John D., Jr., 64 Romney, Gov Mitt, 107, 108 Index Roosevelt, Theodore, 64–65 Rose, Pete, 27 Rothman, Cappy, 73–74 Rousseau, Jean-Jacques, 147n37 Ruiz, Rosie, 30 Running on Ritalin (Diller), 59 Sanctity (sacredness), 93–94 Sanger, Margaret, 65 SAT prep courses, 51, 55 Savulescu, Julian, 47–48 Scalia, Justice Antonin, 42 Schools, standardized tests in, 58–59 Science, 9, 50, 58 Sex selection, 5, 19–23, 49, 86 Sexual orientation, 23, 71, 72 Shapiro, Judith R., 54 Singapore, 69–70 Sinsheimer, Robert L., 97–99 Solidarity, giftedness and, 85, 86, 89–92, 95 Sorites paradox, 118 Sound amplification systems, 39–41 Spectacle: performing arts as, 40–42; sports as, 12, 35, 36–37 Sperm, 8, 22; donors of, 74, 107–108; market in, 72, 74– 75, 128 Sperm banks, 73–74 Spina bifida, 19 Sports: corruption of game’s essence, 36–38; degeneration into spectacle, 12, 35, 36–37, 43–44; effort versus gift in, 26–29; enhanced and unenhanced competitions, 41; genetically altered ath- letes, 11–13; hyperparenting and, 52–54; performance enhancement in, 29–36, 87–88; Scalia’s view of, 42–43 Stem cell research: Bush administration policy on, 102– 103, 107, 119–121; cloned versus “spare” embryos, 104–111, 153n13; degenerative diseases and, 101–102; moral questions concerning, 102–104, 112–128 Sterilization, eugenic: forced, 51, 65–66, 68, 76; free-market incentives for, 69–70 Steroids, 11, 25, 61; banning of, 35; weight gain in athletes and, 34, 35 Supreme Court, U.S., 42–43, 66 Sweeney, H Lee, 10–11 Talents, natural, 29, 37, 44 Talmud, 19 Technology, 37, 41, 44; instrumentalizing tendencies of, 127; parenting and, 48, 51, 78–79 See also Biotechnology Telos (purpose): of medicine, 47; of sport, 38, 42 Theology and theologians, 9, 45, 79–80 Theory of Justice, A (Rawls), 77 Tommasini, Anthony, 40–41 Unbidden, openness to, 45, 46, 86 161 Index United States: cloning in, 105; eugenics in, 64–66, 68; fertility clinics in, 110–111 Watson, James, 70–72 Wikler, Daniel, 76 Williams, Richard, 52 Williams, Serena, 52 162 Williams, Venus, 52 Woods, Earl, 52 Woods, Tiger, 30–31, 52 World Anti-Doping Agency, 33–34, 136n6 Wrestling, as sport, 37, 38 Zygotes, 116, 127, 153n1 [...]... choosing in advance the genetic makeup of the child, the parents consign her to a life in the shadow of someone who 6 The Ethics of Enhancement has gone before, and so deprive the child of her right to an open future The autonomy objection can be raised not only against cloning but also against any form of bioengineering that allows parents to choose their child’s genetic characteristics According to... nature, and about the proper stance of human beings toward the given world Since these questions verge on theology, modern philosophers and 9 The Case against Perfection political theorists tend to shrink from them But our new powers of biotechnology make them unavoidable Genetic Engineering To see how this is so, consider four examples of bioengineering already on the horizon: muscle enhancement, memory... above In exchange for an egg from a donor meet2 The Ethics of Enhancement ing this description, the ad offered payment of $50,000.3 Perhaps the parents who offered the hefty sum for a premium egg simply wanted a child who resembled them Or perhaps they were hoping to trade up, trying for a child who would be taller or smarter than they Whatever the case, their extraordinary offer did not prompt the public... unfair advantage over his unenhanced competitors But the fairness argument against enhancement has a fatal flaw It has always been the case that some athletes are better endowed, genetically, than others And yet we do not consider the natural inequality of genetic endowments to undermine the fairness of competitive sports From the standpoint of fairness, 12 The Ethics of Enhancement enhanced genetic differences... becomes less active as people age The extra copies installed in the mice were programmed to remain active even in old age, and the improvement was passed on to their offspring.9 Of course human memory is more complicated 13 The Case against Perfection than recalling simple associations But biotech companies with names like Memory Pharmaceuticals are in hot pursuit of memory-enhancing drugs, or “cognition... The Case against Perfection abortion of female fetuses has become a familiar practice In India, the number of girls per 1,000 boys has dropped from 962 to 927 in the past two decades India has banned the use of prenatal diagnosis for sex selection, but the law is rarely enforced Itinerant radiologists with portable ultrasound machines travel from village to village, plying their trade One Bombay clinic... equivalent to infanticide Whatever its merits, however, this “pro-life” objection is not an argument against sex selection as such It is an argument against all forms of embryo screening, including PGD carried out to screen for genetic diseases Because the pro-life objection finds an overriding moral wrong in the means (namely, the discarding of unwanted embryos), it leaves open the question of whether there... procreation in one crucial respect: whatever these parents did to increase the odds, they were not guaranteed the outcome they sought Both attempts were still subject to the vagaries of the genetic lottery This defense raises an intriguing question Why does some element of unpredictability seem to make a moral difference? Suppose biotechnology could remove the uncer3 The Case against Perfection tainty and... to learn Mandarin on the eve of his departure for Shanghai It might be argued, against the project of memory enhancement, that there are some things we would rather forget For the drug companies, however, the desire to forget represents not an objec14 The Ethics of Enhancement tion to the memory business but another market segment Those who want to blunt the impact of traumatic or painful memories... wrong with reengineering our nature Consider again the question of cloning The birth of Dolly the cloned sheep in 1997 brought a torrent of worry about the prospect of cloned human beings There are good medical reasons to worry Most scientists agree that cloning is unsafe and likely to produce offspring with serious abnormalities and birth defects (Dolly died a premature death.) But suppose cloning technology